Intractable or Treatment Resistant Depression (TRD)

What is it?

Intractable means goes on for a long time. Treatment Resistant Depression or TRD is therefore usually defined as non-response to attempts at treating depression with an adequate dose for an adequate time of two or more anti-depressants, and following a complete psychiatric assessment.

Symptoms

Not all anti-depressants are as effective as others, and they each suit different individuals. No anti-depressant treatment works in everyone and it is common for each individual patient to experience and tolerate the side effects in different ways. Almost two thirds of patients still experience ongoing incapacitating symptoms after their initial treatment, and for some it takes much trial and error to find a treatment which works. For other patients, initially successful treatment may fade in benefit with time leading to a recurrence of their symptoms.

Treatment

The management of TRD therefore requires a careful and detailed assessment, including the severity of your symptoms, ruling out any other possible causes of the depressive symptoms you may have. Careful consideration will also be given to alternative anti-depressants you could try and in what order, which are then carefully tailored to your needs by balancing benefit against tolerability. The place of talking therapies such as Cognitive Behavioural Therapy (CBT) will also be discussed with you as part of an agreed treatment plan which may also include newer drugs, drug combinations or other additional therapies. The crucial factor is usually the selection of a treatment with minimal intolerable side effects, and which is done as quickly as possible, not only to relieve suffering, but also to prevent further worsening.

It is our belief that almost every person with depression can be helped eventually and hence no one should ever be dismissed as untreatable.

Initial consultations include 60 minutes with the consultant psychiatrist, a written treatment plan, a letter to the GP (with patient’s agreement) and a written prescription, if applicable.

ADHD Assessments

1.5 hour consultation and report £650

Please note, it is our policy that appointment fees for all appointments are paid in advance. Payments can be made by cheque or most major credit/debit cards.

Private Health Insurance
Patients with private health insurance, such as BUPA, may be able to claim the costs of their treatment from their health insurance provider. Normally a referral letter from your GP will be required to do this. Please contact your health insurance provider direct to confirm whether your treatment would be covered.

Standard Occupational Health Report - £950.

This price may vary for more complicated cases. Please contact us to discuss your requirements in more detail or for more information.

Details of fees for psychiatric Medico-legal Reports are available on request. Please contact us for further details.